Physician Micro Systems, Inc. (PMSI), the vendor of the Practice Partner electronic medical record (EMR), is submitting this application in collaboration with its affiliated research network, the Practice Partner Research Network (PPRNet). PPRNet is a consortium of primary health care providers practicing in 25 States and academic researchers from 3 Universities. The purpose of the demonstration project proposed in the application is to expand PPRNet's successful approach to quality improvement in primary care practice, validated in an ongoing project as part of AHRQ's Translating Research into Practice (TRIP) II initiative (Grant No. 1 U18 HS 11132-01). The proposed project will address practice guidelines for priority conditions and improvement approaches advocated in the recent Institute of Medicine (IOM) report and Healthy People 2010 activities. Approved adherence with 73 practice guidelines in eight clinical areas will be the aim of the project. These areas are: heart disease and stroke, diabetes mellitus, cancer screening, immunizations, respiratory disease/infectious disease, mental health and substance abuse, nutrition and obesity, and drug prescribing in the elderly. The project will employ a multi-method intervention in 100 community-based primary care practices caring for up to one million patients, designed to help them adopt a multi-component quality improvement model. The intervention, based on well-accepted theories of TRIP, has three major components: practice reports, site visits, and network meetings. The improvement model incorporates evidence-based strategies of teamwork, organizational change, patient activation, individualized and population-based medicine, and EMR. Each PPRNet practice has the same EMR and share data for quality improvement work. PPRNet's large longitudinal database of clinical information, infrastructure, and experience with practice-based quality improvement provide the unique opportunity to successfully conduct this project. Since EMR use is increasing, this project's findings would be applicable to primary care practices that care for the majority of Americans.